San Francisco Mayor London Breed provided a sobering update on the coronavirus pandemic Tuesday and said the city will need to take “more restrictive action” this week to temper the explosion of coronavirus cases. New health protocols could come as early as tomorrow.

Breed said the city is reviewing a new public health order implemented by Santa Clara County on Monday and is considering similar measures, including limits on retail capacity and a more stringent travel quarantine. Restrictions on gatherings are also in discussion.

“Let me be clear, it’s not good,” the mayor said. “Cases are spiking. Hospitalizations are increasing. Our infection rate is at a higher point than where it was this summer…Our dangerous winter has arrived. The truth is we’re going to have to take more restrictive action. Santa Clara added mandatory travel quarantines. These are things we have to consider.”

Amid a surge, Los Angeles County shuttered outdoor dining and while Mayor Breed said that’s not an immediate step in the city’s plan, it’s not off the table.

“Unfortunately, we can’t rule it out,” she said. “As soon as we see it’s necessary, it could be a possibility, but we can’t say what that would mean in a timeline… We will make sure we provide as much notification as we can as soon as we can.”

The city’s Health Director Dr. Grant Colfax provided an update on the virus spread and said in the last three weeks, daily new cases have tripled with the city now reporting an average of 140 new cases a day.

“We don’t expect this to stabilize any time soon,” Colfax said. “We have more virus circulating than ever before.”

Hospitalizations of COVID patients have doubled in the last 10 days and Colfax said a bed shortage is imminent just before Christmas.

“That is a sobering thought,” he said. “San Franciscans sick from COVID-19 around the December holidays with no available beds at our local hospitals. We hope this doesn’t happen, but it’s an increasing likelihood as we see this virus spreads locally like never before.”

In Santa Clara County, a mandatory 14-day quarantine for residents and travelers entering the region from more than 150 miles away went into effect Monday. The new rule limits hotels in the county to only essential travelers. Colfax said a similar requirement could be issued in San Francisco as early as Wednesday.